How are Indians dying? And why is it important to know?

Once again, as every year, it’s Pitru Paksha period in India – those 15 days when many Indians will pay homage to their ancestors. While a lot of Indians will earnestly pray for the well-being of their ancestors, hardly any will know for sure how the ancestors had died. We still don’t know how most Indians die. And this lack of knowledge is standing as a huge obstacle in improving public health in India.

Registration of births and deaths is compulsory in India as per the Births & Deaths Act, 1969. Registrars have been appointed in various local areas for such registration as a part of this Act. Now even online registration of births and deaths has begun. Despite this, majority of Indians don’t register births or deaths. Most of the time when they do register deaths, it is done for purposes like transferring property than as a crucial public health activity.

Even among the deaths registered we don’t know what the medical cause of death was. The percentage of medically certified deaths among all registered deaths varies for different states as per the Report on Medical Certification of Cause of Death-2013 of the Registrar General of India (RGI). Ranging anywhere from as low as 0.4% in Jharkhand to 100% in Goa and Lakshadweep, this depends on the presence and access to health facilities in each state. As we also know from the Global Burden of Disease data from India on mortality, the situation is worse in rural areas for which most of the information on cause of death comes from verbal autopsies which are often an inaccurate proxy for knowing cause of death.

The issues don’t end there. There are severe faults in our medical education system where medical graduates are not taught clearly how to fill death certificates and how to ascertain cause of death. And this is above and beyond the lack of doctors that India faces. Overall, the scenario suggests that knowing the causes of death and analysing such information for public health purposes in order to develop public health planning and strategical thinking to prevent the most common causes of death is almost entirely missing in the Indian health system.

The entire current system of underreporting of deaths whose causes we don’t know keeps us perpetually in the loop of annually fighting against dengue deaths on one side while doing little to counter the rising challenge of non-communicable diseases and road traffic accidents on the other. We must understand that knowing how one dies is as important as ensuring well-being after one has died.

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